Wrinkler, Sinker or Sagger—Which Facial Aging Style Are You?

Aging is an individual experience. While one might assume that all signs of aging are essentially the same, they’re not. The way your face ages can be classified into three different categories. You’re either a wrinkler, sinker, sagger or a combination. “In general, these terms refer to different ways that people age,” explains Beverly Hills, CA dermatologist Ava Shamban, MD. “In practice, most people have a combination of at least one or two of these signs.” The terms were coined by Dr. Shamban’s Canadian mentor, Kent Remington, MD. Understanding how your skin ages can help you more easily address signs of aging. “Each of these types of patients has very different looks,” says Dr. Shamban. “Etched lines (wrinkler), heavy lower face (sinker) and lots of loose skin (sagger) pick your poison!”

Signs you’re a wrinkler

According to Dr. Shamban, a wrinkler “is someone whose epidermis has multiple criss cross lines. These lines can be deeper or more finely etched, but the characteristic is a face that looks like a roadmap.” Nanuet, NY dermatologist Heidi Waldorf, MD says a sign that you’re a wrinkler would be if you can see wrinkles at rest, “lines etched in the skin rather than folds of skin over skin.” This kind of aging is generally related to photodamage, cigarette smoking or wear and tear from movement, says Dr. Waldorf.

A wrinkler generally shows creasing around the mouth (upper lip), cheeks and eyes (crow’s feet), says Washington, D.C. dermatologist Tina Alster, MD. She notes that “wrinklers tend to have fair skin which is more prone to ultraviolet light destruction of elastic fibers (and therefore more wrinkling).”

Solutions for wrinklers

The way wrinkles are best treated depends on their cause. If your wrinkles are related to movement, “the time to start treating is when you see them with movement before you see them remain at rest,” says Dr. Waldorf. She suggests botulinum toxin to stop or reduce movement in the area, which helps diminish the appearance of lines and their eventual deepening. “Lines that are still visible can be treated with superficial filler and sometimes subcision,” says Dr. Waldorf.

If your wrinkles are photoaging-related, Dr. Waldorf suggests a peel with lasers or chemicals. This will essentially force “the skin to replace the damage with new skin.” She adds that topical sun protection and retinoids are also a must. “Additional topicals like Alastin, which contain proprietary peptides that help to turn over old elastic and collagen, are helpful adjuncts.” 

Dr. Shamban says hyaluronic acid filler and Sculptra are also great treatments for wrinklers. Dr. Alster suggests ablative or non-ablative laser skin resurfacing and microneedling as other options.

Signs you’re a sinker

Dr. Waldorf sums up a sinker as someone who has volume loss. “A sinker is someone whose primary signs of aging are fat pad loss and descent,” explains Dr. Shamban. “This person will have heavy jowls, flat pancake-like mid-face and kind of a doughy lower face.” 

Other tell-tale signs include “the deepening of central face skin folds like the nasolabial folds as we lose fat and bone laterally (from the sides of the face),” says Dr. Waldorf. “Without support from the sides of the face, the overlying skin falls toward the middle.” The same phenomenon can occur with the jowls. 

“Loss of deep fat in the middle of the face takes away the smooth transitions between the eyelids and cheek, giving the appearance of hollows, bags or darkness under the eyes,” says Dr. Waldorf. To see if you’re a sinker, she instructs patients to see how many fingers fit into their temples, above their lateral eyebrow and in the hollow of their nose. Additionally, “you can see volume loss in the central face and tear trough area by making the ‘home alone’ face (long face with the chin dropped and mouth open in an oval) and look for the triangular hollow on either side of the nose in the mid-cheek.”

Solutions for sinkers

To treat volume loss, Dr. Waldorf likes to replace the absent volume with filler, a biostimulator or fat. Additionally, fixing dental issues can help the perioral area. A silhouette lift can help shift volume that’s fallen centrally outward, notes Dr. Waldorf. “When combinations of these noninvasive procedures aren’t enough, a surgical facelift that includes moving fat pads and tightening the underlying structures may be necessary,” she adds. Dr. Shamban suggests Ultera, Sofwave or threads for sinkers.

Signs you’re a sagger

A sagger is “someone whose skin hangs in folds, and you can lift it up like a hanging curtain. Also, this person will have deep folds around their mouth and deep marionette lines,” says Dr. Shamban. This lax appearance is a result of depleted elasticity and structural collagen support, explains Dr. Waldorf. 

“This tends to be most evident along the jawline, neck and under the chin. It’s like hanging cloth or an empty balloon,” says Dr. Waldorf. Dr. Alster says hollow cheeks can also be a sign that you’re a sagger. Sagging is related to aging and not necessarily sun exposure, she notes.

Solutions for saggers

What makes improving sagging challenging is that simply “filling it up” can result in looking like “an overfilled balloon,” warns Dr. Waldorf. Mild to moderate laxity can be addressed with biostimulators, like Hyperdilute Radiesse or Sculptra, laser or radiofrequency resurfacing and ultrasound or radiofrequency skin tightening, says Dr. Waldorf. Dr. Alster also suggests noninvasive tissue tightening, like Ulthera or Thermage and Silhouette InstaLift sutures. Meanwhile, Dr. Shamban recommends micro-coring or traditional CO2 resurfacing. However, the experts agree, severe laxity will most likely require surgery because there is too much skin.

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